Meta-Analysis of the Quantitative Relation Between Pulse Pressure and Mean Arterial Pressure and Cardiovascular Risk in Patients With Diabetes Mellitus
Meta-Analysis of the Quantitative Relation Between Pulse Pressure and Mean Arterial Pressure and Cardiovascular Risk in Patients With Diabetes Mellitus
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DOI：
10.1016/j.amjcard.2013.12.005
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发表时间：
2014-03-15
影响因子：
2.8
通讯作者：
Sone, Hirohito
中科院分区：
文献类型：
--
作者：
Kodama, Satoru;Horikawa, Chika;Sone, Hirohito
在糖尿病患者中，研究脉压（PP）和平均动脉压（MAP）在心血管疾病（CVD）风险方面的意义的流行病学研究结果不一致。我们进行了定量荟萃分析来估计与PP或MAP相关的心血管疾病风险。对提供糖尿病患者基线MAP或PP增加的CVD风险数据的前瞻性研究进行了电子文献检索。采用随机效应模型估计每个血压（BP）指数升高10 mm Hg的合并CVD风险。共有17项合格研究，包括52，647例患者和5，112例CVD病例。对于10 mm Hg的增量，PP和MAP的CVD合并相对风险（95%置信区间）分别为1.10（1.04 - 1.16）和1.09（0.98 - 1.21）。观察到显著的研究间异质性（I-2 [p值]; PP为76.5% [p < 0.001]，MAP为67.8% [p = 0.005]）。在同时研究4个指标的CVD风险的研究中（即，PP、MAP、收缩压和舒张压的合并相对危险度（95%可信区间）分别为1.17（1.09 - 1.26）、1.11（1.06 - 1.15）、1.14（1.06 - 1.22）和1.06（0.94 - 1.19）。总之，目前的荟萃分析表明，PP是4个常用BP指标中最强的指标。然而，较大的异质性促使对研究结果进行谨慎解释。(c)2014 Elsevier Inc. All rights reserved.
Results of epidemiologic studies that investigated the significance of pulse pressure (PP) and mean arterial pressure (MAP) in terms of risk of cardiovascular disease (CVD) in patients with diabetes mellitus are inconsistent. We performed a quantitative meta-analysis to estimate CVD risk in relation to PP or MAP. Electronic literature search was conducted for prospective studies providing data on CVD risk for an increment in baseline MAP or PP in patients with diabetes mellitus. The pooled CVD risk for a 10-mm Hg increase in each blood pressure (BP) index was estimated with a random-effects model. There were 17 eligible studies consisting of 52,647 patients and 5,112 CVD cases. The pooled relative risk (95% confidence interval) of CVD for an increment of 10 mm Hg was 1.10 (1.04 to 1.16) for PP and 1.09 (0.98 to 1.21) for MAP. Significant between-study heterogeneity was observed (I-2 [p value]; 76.5% [p < 0.001] for PP, 67.8% [p = 0.005] for MAP). In studies concurrently investigating CVD risk for the 4 indexes (i.e., PP, MAP, systolic BP, and diastolic BP), the pooled relative risk (95% confidence interval) was 1.17 (1.09 to 1.26) for PP, 1.11 (1.06 to 1.15) for MAP, 1.14 (1.06 to 1.22) for systolic BP, and 1.06 (0.94 to 1.19) for diastolic BP. In conclusion, the current meta-analysis suggested that PP was the strongest indicator among the 4 commonly used BP indexes. However, the large heterogeneity urged cautious interpretation of the study results. (c) 2014 Elsevier Inc. All rights reserved.